Abstract Objective We assessed the risk for physical inactivity due to inadequate health literacy using multivariable analysis in a large middleaged population. Methods This cross-sectional mail survey using a self-administered questionnaire was conducted in 2020 and included 33,902 community residents aged 40–64 years from 5 cities in Osaka Prefecture, Japan. Of these, 12,446 (36.7%) agreed to participate in the survey. After exclusion of those with regular visits to medical institutions and those with missing data, the analysis included 3742 participants. Health literacy was measured by the communicative and critical health literacy (CCHL) scale, and participants were classified into 3 groups (low, medium, and high health literacy groups) by the tertiles of the CCHL scale score. Physical inactivity was defined as not completing at least 150 min of moderate-intensity physical activity throughout the week. Results After adjustment for age, gender, education level, occupation, economic status, living alone, and stages of health behavior change, the multivariable-adjusted odds ratios (ORs) for physical inactivity were 1.36 (95% confidence interval CI: 1.16–1.59, P < 0.001) in the medium health literacy group and 1.70 (95% CI: 1.36–2.11, P < 0.001) in the low health literacy group compared with the high health literacy group. Conclusions This large-scale study provides compelling evidence that those with inadequate health literacy are at higher risk for physical inactivity among middle-aged adults.
Sonoda et al. (2026) studied this question.